HHS Secretary Tom Price has tipped his hand and revealed some potentially controversial stances on his preferred measures for repealing and replacing the Affordable Care Act.
Responding to questions from lawmakers during his confirmation process, Price said healthcare reform should allow states to choose if they want to charge women more for coverage; he also supported capping Medicaid funding and using high-risk pools to provide coverage for people with pre-existing conditions.
Price's written responses have not been released publicly, but were provided exclusively to Modern Healthcare. The responses give a more candid look at the ideas that Price may push for Congress and President Donald Trump to support. Several suggestions are already under consideration in a bill set to be marked up by the House Wednesday.
An HHS spokesman said the ideas that Price is championing for Congress to incorporate into healthcare legislation will return authority to the states and empower patients by providing them with financial relief, more choices and higher quality care than they currently receive.
In his written response to Senate Finance Committee Ranking Member Ron Wyden's question on whether insurance companies should be required to charge men and women the same rate for premiums, Price indicated the matter may be best addressed by states.
“The setting of premiums is something that has historically been a matter of state law and regulation, so that the dynamics of that state and its population and risk pool and consumer behavior can be taken into account,” Price said.
Before the Affordable Care Act, insurance companies were charging women more for their health insurance compared to men. A 2012 report from the National Women's Law Center found that women were paying $1 billion more annually for health insurance than men.
Price's response misses the point of the ACA's premium rate-setting reforms, according to Dania Palanker, an assistant research professor at Georgetown University's Center on Health Insurance Reforms. The healthcare reform law didn't repeal states' responsibilities to oversee rate-setting, it just prevented insurers from discriminating against women with their rates, she said.
If those protections went away, the implications would be severe, according to Jean Hall, director of the Institute for Health and Disability Policy Studies at the University of Kansas.
“The end result of charging women more for coverage is that they cannot afford insurance, so many costs for pregnancies are shifted to public programs like Medicaid,” Hall said. “Thus, we all pay more.”